Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan.
Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
PLoS One. 2019 Aug 26;14(8):e0221791. doi: 10.1371/journal.pone.0221791. eCollection 2019.
In Japan, a range of patients with traumatic brain injury (TBI) has been recorded in a nationwide database (Japan Neurotrauma Data Bank; JNTDB). This study aimed to externally validate three international prediction models using JNTDB data: Trauma and Injury Severity Score (TRISS), Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT). We also aimed to validate the applicability of these models in the Japanese population. Of 1,091 patients registered in the JNTDB from July 2009 to June 2011, we analyzed data for 635 patients. We examined factors associated with mortality in-hospital and unfavorable outcomes 6 months after TBI by applying the TRISS, CRASH, and IMPACT models. We also conducted an external validation of these models based on these data. The patients' mean age was 60.1 ±21.1 years, and 342 were alive at the time of discharge (53.9%). Univariate analysis revealed eight major risk factors for mortality in-hospital: age, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic blood pressure, heart rate, mydriasis, acute epidural hematoma (AEDH), and traumatic subarachnoid hemorrhage. A similar analysis identified five risk factors for unfavorable outcomes at 6 months: age, GCS, ISS, mydriasis, and AEDH. For mortality in-hospital, the TRISS had a satisfactory area under the curve value (0.75). For unfavorable outcomes at 6 months, the CRASH (basic and computed tomography) and IMPACT (core and core extended) models had satisfactory area under the curve values (0.86, 0.86, 0.81, and 0.85, respectively). The TRISS, CRASH, and IMPACT models were suitable for application to the JNTDB population, indicating these models had high value in Japanese patients with neurotrauma.
在日本，一项全国性数据库（日本神经创伤数据库；JNTDB）记录了一系列创伤性脑损伤（TBI）患者。本研究旨在使用 JNTDB 数据对三种国际预测模型（创伤和损伤严重程度评分（TRISS）、颅脑损伤后皮质类固醇随机分组（CRASH）和国际创伤后预后和临床试验分析（IMPACT））进行外部验证。我们还旨在验证这些模型在日本人群中的适用性。在 JNTDB 中，2009 年 7 月至 2011 年 6 月期间登记了 1091 名患者，我们分析了其中 635 名患者的数据。我们通过应用 TRISS、CRASH 和 IMPACT 模型，分析了与创伤后住院期间死亡率和 6 个月不良结局相关的因素。我们还根据这些数据对这些模型进行了外部验证。患者的平均年龄为 60.1±21.1 岁，出院时 342 人存活（53.9%）。单因素分析显示，住院期间死亡的 8 个主要危险因素为：年龄、格拉斯哥昏迷量表（GCS）、损伤严重程度评分（ISS）、收缩压、心率、瞳孔散大、急性硬膜外血肿（AEDH）和创伤性蛛网膜下腔出血。类似的分析确定了 6 个月时不良结局的 5 个危险因素：年龄、GCS、ISS、瞳孔散大和 AEDH。对于住院期间的死亡率，TRISS 的曲线下面积值（0.75）令人满意。对于 6 个月时的不良结局，CRASH（基础和计算机断层扫描）和 IMPACT（核心和核心扩展）模型的曲线下面积值（0.86、0.86、0.81 和 0.85）均令人满意。TRISS、CRASH 和 IMPACT 模型适用于 JNTDB 人群，表明这些模型在日本神经创伤患者中具有很高的价值。
